Laparoscopic bipolar electrosurgical instrument

ABSTRACT

A laparoscopic bipolar electrosurgical instrument can apply a large closure force between its jaws without damaging the small yoke assembly. The instrument comprises: a first jaw having a first flange with a first slot, and a second jaw having a second flange with a second slot, wherein the first and second jaws are located at a distal end of the instrument and comprise an electrically conductive material for conducting bipolar electrosurgical current therebetween; a yoke attached to a pushrod and positioned to electrically insulate the first flange from the second flange, the yoke having a first side facing the first flange and a second side facing the second flange, the yoke further comprising a first shoulder and a second shoulder; a first pin located on the first side and movably engaged with the first slot; a second pin located on the second side and movably engaged with the second slot; the first slot and the second slot shaped such that an angle, subtended by the first and second jaws, decreases with distal motion of the pushrod, and first and second cul-de-sacs positioned respectively in the first and second slots to relieve shear stresses on the first and second pins approximately when the first and second shoulders respectively engage the first and second flanges to provide a closure force between the first and second jaws.

This application is a continuation of U.S. application Ser. No.08/970,472 filed on Nov. 14, 1997, now U.S. Pat. No. 6,228,083.

FIELD OF THE INVENTION

This relates to an electrosurgical instrument for performinglaparoscopic surgical procedures, and more particularly to alaparoscopic electrosurgical instrument that is capable of graspingvessels and vascular tissue with sufficient force between two bipolarjaws to seal the vessel or vascular tissue.

BACKGROUND OF THE DISCLOSURE

Laparoscopic surgical instruments are used to perform surgical operationwithout making large incisions in the patient. The laparoscopicinstruments are inserted into the patient through a cannula, or port,that has been made with a trocar. Typical sizes for cannulas range fromthree millimeters to twelve millimeters. Smaller cannulas are usuallypreferred, and this presents a design challenge to instrumentmanufacturers who must find ways to make surgical instruments that fitthrough the cannulas.

Certain surgical procedures require cutting blood vessels or vasculartissue. This sometimes presents a problem for surgeons because it isdifficult to suture blood vessels using laparoscopic tools. Very smallblood vessels, in the range below two millimeters in diameter, can oftenbe closed using standard electrosurgical techniques. If a larger vesselis severed, it may be necessary for the surgeon to convert thelaparoscopic procedure into an open-surgical procedure and therebyabandon the benefits of laparoscopy.

Several journal articles have disclosed methods for sealing small bloodvessels using electrosurgery. An article entitled Studies on Coagulationand the Development of an Automatic Computerized Bipolar Coagulator, J.Neurosurg., Volume 75, Jul. 1991, describes a bipolar coagulator whichis used to seal small blood vessels. The article states that it was notpossible to safely coagulate arteries with a diameter larger than 2 to2.5 mm. A second article is entitled Automatically Controlled BipolarElectrocoagulation—“COA-COMP”, Neurosurg. Rev. (1984), pp. 187-190. Thisarticle describes a method for terminating electrosurgical power to thevessel so that charring of the vessel walls can be avoided.

It has been recently determined that electrosurgical methods may be ableto seal larger vessels using an appropriate electrosurgical power curve,coupled with an instrument capable of applying a large closure force tothe vessel walls. It is thought that the process of coagulating smallvessels is fundamentally different than electrosurgical vessel sealing.Coagulation is defined as a process of desiccating tissue wherein thetissue cells are ruptured and dried. Vessel sealing is defined as theprocess of liquefying the collagen in the tissue so that it crosslinksand reforms into a fused mass. Thus, coagulation of small vessels issufficient to permanently close them. Larger vessels need to be sealedto assure permanent closure.

It would be desirable to have a surgical tool capable of applyingelectrosurgical energy, capable of applying a large closure force to thevessel walls, and also capable of fitting through a cannula. A largeclosure force between the jaws typically requires a large moment aboutthe pivot for each jaw. This presents a challenge because the first andsecond pins have a small moment arm with respect to the pivot of eachjaw. A large force, coupled with a small moment arm, is undesirablebecause the large forces may shear the first and second pins. It is alsoundesirable to increase the moment arm of the first and second pinsbecause the physical size of the yoke might not fit through a cannula.

Several bipolar laparoscopic instruments are known. For example, U.S.Pat. No. 3,938,527 discloses a bipolar laparoscopic instrument for tubalcauterization. U.S. Pat. No. 5,250,047 discloses a bipolar laparoscopicinstrument with a replaceable electrode tip assembly. U.S. Pat. No.5,445,638 discloses a bipolar coagulation and cutting forceps with firstand second conductors extending from the distal end. U.S. Pat. No.5,391,166 discloses a bipolar endoscopic instrument having a detachableworking end. U.S. Pat. No. 5,342,359 discloses a bipolar coagulationdevice.

The present invention solves the problem of providing a large closureforce between the jaws of a laparoscopic bipolar electrosurgicalinstrument, using a compact design that fits through a cannula, withoutrisking structural failure of the instrument yoke.

SUMMARY OF THE INVENTION

The present invention is an instrument for applying bipolarelectrosurgical current to tissue in a laparoscopic operation with theadded benefit of providing a large closure force between the instrumentjaws. The large closure force may be particularly useful for vesselsealing operations. An advantage of the present invention is that tissuecan be grasped and clamped with a relatively large closure force withoutdamage to the yoke. The yoke is capable of transmitting the largeclosure force to the instrument jaws while being small enough to fitthrough a cannula The laparoscopic bipolar electrosurgical instrumentcomprises first and second jaws having, respectively, first and secondflanges with first and second slots. The instrument is electricallyconnected to an electrosurgical generator, and conducts bipolarelectrosurgical current to the first and second jaws. A yoke is attachedto a pushrod and positioned to electrically insulate the first flangefrom the second flange. First and second pins on the yoke are designedto engage the first and second slots, respectively, in a cam-followerarrangement that opens and closes the jaws with linear motion of theyoke. The yoke is preferably a “push yoke” which means that linearmotion of the yoke in the direction of the distal end of the instrumentwill cause the jaws to close together.

The yoke has first and second shoulders that are spaced apart from thefirst and second flanges until the jaws are in close arcuate proximityto each other. At that point, the first and second shoulders engage thefirst and second flanges, whereby further distal motion of the yokeapplies a force to the first and second flanges that creates a momentabout the pivot of each jaw. In general, the cam-follower arrangement ofpins and slots may be designed to provide coarse motion of the jaws withrelatively small forces. Large closure forces, once the jaws arerelatively close together, may be obtained by pressing the shouldersagainst the flanges. The first and second pins move into cul-de-sacs inthe first and second slots to protect them from large shear stresseswhen the shoulders are applying relatively large forces to the flanges.Thus, the first and second pins may be made from an electricallyinsulative material that is not designed to handle large shear stresses,large closure forces may be obtained, and the entire assembly may becompact and fit through a cannula

A method of making the laparoscopic bipolar electrosurgical instrumentis described, comprising the following steps: forming a first jaw havinga first flange with a first slot, and a second jaw having a secondflange with a second slot; attaching a yoke to a pushrod; electricallyinsulating the first flange from the second flange with the yoke;engaging first and second pins with the first and second slots;positioning first and second cul-de-sacs respectively in the first andsecond slots to relieve shear stresses on the first and second pins at asubtended angle approximately wherein first and second shoulders engagethe first and second flanges.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a laparoscopic bipolar electrosurgicalinstrument.

FIG. 2 is a perspective view of the distal end and jaws of theinstrument in FIG. 1.

FIG. 3 is an exploded view of the distal end shown in FIG. 2.

FIG. 4 is perspective view of the distal end of the instrument with thejaws removed.

FIG. 5 is another perspective of FIG. 4.

FIG. 6 is a side views of an electrical spring contact.

FIG. 7 is a front view of the spring contact shown in FIG. 6.

DETAILED DESCRIPTION OF THE INVENTION

A laparoscopic bipolar electrosurgical instrument 10 is shown in FIG. 1.The instrument 10 has a proximal end 11 with a handle 14 for holding andmanipulating the instrument 10. A distal end 12 on the instrument 10 isused for surgical manipulation of tissue. The instrument 10 comprises anelongate tube 13 that is sized to fit through a cannula for laparoscopicoperations, and in different embodiments may be sized to fit througheither a five or seven millimeter cannula.

A portion of the distal end 12 of the instrument 10 is shown in FIG. 2.A first jaw 15 and a second jaw 16 are shown in an open position. Anangle a is subtended by the jaws 15 and 16. Closing of the jaws 15 and16 is defined as a reduction of the angle a subtended by the jaws 15 and16. Similarly, opening of the jaws 15 and 16 is defined as anenlargement of the angle a. The angle a is zero when the jaws 15 and 16are closed together. The center of rotation for the first jaws 15 is atthe first pivot 41, and the center of rotation for the second jaw 16 isat the second pivot 42. The first pivot 41 is located on an outer nosepiece 32, and fits in a first pivot hole 43 located on the first flange18. The second pivot 42 is located on an inner nose piece 31, and fitsin a second pivot hole 44 located on the second flange 20.

Pieces that comprise the distal end 12 of the instrument 10 are shown inan exploded view in FIG. 3. The first jaw 15 and the second jaw 16 areshown separated from a yoke 17. The first jaw 15 has a first flange 18and a first slot 19 therewithin. The second jaw 16 has a second flange20 and a second slot 21 therewithin. Each jaw 15 and 16 is preferablyformed from a single piece of stainless steel or other electricallyconductive material.

Referring again to FIG. 3, the yoke 17 is attached to a pushrod 22. Theyoke 17 is preferably formed from an electrically insulative materialsuch as plastic. A first side 23 of the yoke 17 faces the first flange18. A second side 24 of the yoke 17 faces the second flange 20. When theyoke 17 is positioned between the flanges 18 and 20, the yoke 17 alsoacts to electrically insulate the first jaw 15 from the second jaw 16.In this manner, bipolar electrosurgical current can be conducted throughtissue grasped by the jaws 15 and 16 without short circuiting betweenthe flanges 18 and 20.

A first pin 25 is located on the first side 23 to movably engage withthe first slot 19. Similarly, a second pin 26 is located on the secondside 24 to movably engage with the second slot 21. Each pin and slotcombination works as a cam-follower mechanical linkage. Motion of thepushrod 22 moves the yoke 17 causing pins 25 and 26 to slide withintheir respective slots 19 and 21. The slots 19 and 21 are angled withrespect to the distal ends of the jaws 15 and 16 such that the jaws 15and 16 move in an arcuate fashion toward and away from each other. Thepins 25 and 26 are different from the pivots 41 and 42. The pins 25 and26 provide a force against the walls of the slots 19 and 21, creating amoment about the pivots 41 and 42.

The slots 19 and 21 are arranged such that distal motion of the pushrod22 causes the jaws 15 and 16 to move together. Distal motion of thepushrod 22 is defined as motion in the direction of the distal end 12 ofthe instrument 10. Once thejaws 15 and 16 are closed together, thepresent invention holds the jaws 15 and 16 together with a compressiveforce on the pushrod 22.

One of the advantages of this invention is that shear forces on the pins25 and 26 can be offloaded to prevent mechanical failure when largeforces are being transmitted to the jaws 15 and 16. Each slot 19 and 20has a cul-de-sac 27 and 28, respectively, as shown in FIG. 3. The firstcul-de-sac 27 is an enlargement of the first slot 19 near its distalend. The second cul-de-sac 28 is an enlargement of the second slot 21near its distal end. The cam-follower motion of the pins 25 and 26 inthe slots 19 and 21 will bring the pins 25 and 26 into their respectivecul-de-sac 27 and 28. This position of the pins 25 and 26 leaves a verysmall moment arm between the pins 25 and 26 and the pivots 41 and 42.The yoke 17 has shoulders 29 and 30 that can provide a relatively largemoment about the pivots 41 and 42 to effect a high closure force betweenthe jaws 15 and 16 without a high shear forces on the pins 25 and 26, asdescribed below.

Once the pins 25 and 26 are in the cul-de-sacs 27 and 28, the force fromthe yoke is transmitted to the flanges 18 and 20 by a first shoulder 29and a second shoulder 30. The shoulders 29 and 30 abut the proximal endof the flanges 18 and 20 to cause the jaws 15 and 16 to close together.The pivots 41 and 42 are preferably made of metal and can withstandrelatively high shear forces. In contrast, pins 25 and 26 are preferablymade of plastic and will break under relatively high shear forces. Thus,the shoulders 29 and 30 provide a moment lo about the pivots 41 and 42,thereby avoiding the necessity of applying high shear forces to the pins25 and 26 when the moment arm from the pins 25 and 26 would be small.There is an angle a at which the pins 25 and 26 enter their respectivecul-de-sacs 27 and 28 and the shoulders 29 and 30 abut the flanges 18and 20. The angle α at which the forgoing occurs is preferably aroundthree degrees.

The bipolar electrosurgical instrument 10 has first and second poles ofalternating potential that are conducted along the instrument 10 andthrough tissue that is grasped between the jaws 15 and 16. The firstpole is conducted from the proximal end 11 toward the distal end 12along the pushrod 22. The second pole is conducted from the proximal end11 toward the distal end 12 along the tube 13. The outer surface of thetube 13 is preferably coated with an electrically insulative material.There is also preferably an electrically insulative barrier between thepushrod 22 and the tube 13 to prevent short circuits in the instrument10.

In the preferred embodiment, the distal end of the instrument 10comprises an inner nose piece 31 and an outer nose piece 32, as shown inFIG. 2. The inner nose piece 3 1 is electrically connected with thepushrod 22, while the outer nose piece is electrically connected withthe tube 13. The inner nose piece 31 and the outer nose piece 32 capturethe yoke 17, along with the first and second flanges 18 and 20, as shownin FIG. 2. The yoke 17 moves axially, along an axis defined by the tube,in a space between the inner and outer nose pieces 31 and 32. A spacerstake 33 maintains the separation of the nose pieces 31 and 32 at theirdistal ends. The nose pieces 31 and 32 provide lateral support for theflanges 18 and 20 to help ensure that the pins 25 and 26 remain withinthe slots 19 and 21. The preferred embodiment also comprises an innerinsulator 34 and an outer insulator 35 for maintaining electricalinsulation between the poles. The outer insulator 35 is seated betweenthe tube 13 and the inner nose 31, as shown in FIGS. 2 and 4. The innerinsulator 34 is seated between the tube 13 and the pushrod 22. In thismanner, the outer nose piece 32 can provide electrical continuitybetween the tube 13 and the second jaw 16, while the inner nose piece 34can provide electrical continuity between the pushrod 22 and the firstjaw 15. Since the pushrod Z ” is slidably mounted within the tube 13,the preferred embodiment has a spring contact 36, as shown in FIGS. 6and 7, mounted on the pushrod 22 to maintain an electrical connectionwith the inner nose piece 34 during axial motion.

The first and second jaws 15 and 16 each have ridges 37 and 38 at theirdistal ends that preferably nest together. The jaws 15 and 16 also haveseal surfaces 39 and 40, as shown in FIG. 2. The width of the sealsurfaces 39 and 40 is a parameter that affects the quality of thesurgical outcome. The closure force between the jaws 15 and 16 variesalong the length of the seal surfaces 39 and 40, with the largest forceat the distal tip and the smallest force at the proximal end of the sealsurfaces 39 and 40. It has been found through experimentation that goodvessel sealing results are obtained when the closure force in gramsdivided by the width in millimeters is in the range of 400 to 650. Sincethe closure force varies with the length of the seal surfaces 39 and 40,it has been found to be advantageous to taper the width of the sealsurfaces 39 and 40 along their length, with the widest width at theproximal end and the narrowest width at the distal end. This designallows the jaws 15 and 16 to apply a relatively constant closure forceper unit width, preferably 525 grams per millimeter width.

A method of making a laparoscopic bipolar electrosurgical instrument 10is also herein described. The method comprises the step of forming afirst jaw 15 having a first flange 18 with a first slot 19, and a secondjaw 16 having a second flange 20 with a second slot 21. The jaws 15 and16 are preferably formed in a casting process, although it is alsopossible to machine the jaws 15 and 16 from stock. The casting processmay include injecting powdered metal under pressure into a mold, andthen applying heat.

Other steps in the method include attaching a yoke 17 to a pushrod 22,and electrically insulating the first flange 18 from the second flange20 with the yoke 17. The yoke 17 is preferably an injection moldedplastic part with features including a first shoulder 29 and a secondshoulder 30.

During assembly of the distal portion of the instrument 10, steps in themethod include engaging a first pin 5 with the first slot 19, andengaging a second pin 26 with the second slot 21. The slots 19 and 21are shaped such that a subtended angle a between the first and secondjaws 15 and 16 decreases with distal motion of the pushrod 17, and theslots 19 and 20 are formed with cul-de-sacs 27 and 28 positioned torelieve shear stresses on the first and second pins 25 and 26 at thesubtended angle α approximately wherein the first and second shoulders29 and 30 engage the first and second flanges 18 and 20.

Further steps in the method comprise: surrounding at least a portion ofthe pushrod 22 with an electrically conductive tube 13; electricallyinsulating the tube 13 from the pushrod 22; electrically connecting aninner nose piece 31 to the pushrod 22, and electrically connecting anouter nose piece 32 to the tube 13, wherein the inner nose piece 31 andthe outer nose piece 32 capture the yoke 17 along with the first andsecond flanges 18 and 20 to conduct bipolar electrosurgical current tothe first and second jaws 15 and 16. In the preferred embodiment, thereis a step of electrically connecting the pushrod 22 and the inner nosepiece 31 with a spring contact 36.

The method of making the instrument 10, in some embodiments, includesthe steps of tapering the width of the seal surfaces 39 and 40 along thelength of each of the first and second jaws 15 and 16.

While a particular preferred embodiment has been illustrated anddescribed, the scope of protection sought is in the claims that follow.

What is claimed is:
 1. A laparoscopic bipolar endoscopic instrument,comprising: first and second jaw members, one of the jaw members beingmovable relative to the other of the jaw members from a first openposition wherein the jaw members are disposed in spaced relationrelative to one another to a second clamping position wherein the jawmembers cooperate to grasp tissue therebetween, an electricallyconductive push rod for connecting the first jaw member to a firstelectrical potential and an electrically conductive tube for connectingthe second jaw member to a second electrical potential such that the jawmembers are capable of conducting bipolar energy through the tissue heldtherebetween; a yoke having at least one pin attached thereto whichslidably engages the law members, the yoke being movable such that thepin imparts movement of the jaw members from the first and secondpositions; a pair of shoulder portions attached to the yoke which areconfigured to abut the jaw members when the jaw members are moved intothe second position to relieve shear stress on the pin during clampingand sealing of the tissue; and a handle which cooperates with the pushrod for imparting movement to the yoke.
 2. The laparoscopic bipolarelectrosurgical instrument of claim 1 wherein the electricallyconductive tube surrounds at least a portion of the pushrod, and anelectrically insulative layer is disposed between the tube and thepushrod capable of supporting an electrosurgical alternating potentialacross the tube and the pushrod.
 3. The laparoscopic bipolarelectrosurgical instrument of claim 2 further comprising: an inner nosepiece electrically connected to the pushrod, and an outer nose pieceelectrically connected to the tube, wherein the inner nose piece and theouter nose piece capture the yoke to conduct bipolar electrosurgicalcurrent to the first and second jaw members.
 4. The laparoscopic bipolarelectrosurgical instrument of claim 3 further comprising an electricalspring contact between the pushrod and the inner nose piece to provideelectrical continuity therebetween.
 5. The laparoscopic bipolarelectrosurgical instrument of claim 1 further comprising ridges in eachof the first and second jaw members.
 6. The laparoscopic bipolarelectrosurgical instrument of claim 1 wherein each of the first andsecond jaw members has a seal surface with width and a length, andwherein at least one location along the length has a width such that theclosure force in grams divided by the width in millimeters is in therange of 400 to
 650. 7. The laparoscopic bipolar electrosurgicalinstrument of claim 6 wherein the width of at least one of the sealsurfaces is tapered along its respective length.
 8. The laparoscopicbipolar electrosurgical instrument of claim 7 wherein the closure forcein grams divided by the width in millimeters is approximately constantalong the length for each of the first and second jaw members.